Tracheal tubes

ABSTRACT

A tracheal tube for use in intubating a trachea, and which embodies passageways and openings therein which are constituted and arranged in a manner particularly effective for the passage of suction catheters, and the like, therethrough into bronchi, and the like. The tube preferably embodies a cuff mounted on the end and sides thereof for effecting a seal between the tube and the trachea, and for protecting the trachea against injury. The cuff embodies resilient means for maintaining it in expanded position, and is contractible by means of a vacuum applied thereinto by a secondary tube mounted on the tracheal tube.

United States Patent [191 Kamen Mar. 26, 1974 TRACHEAL TUBES [76]Inventor: Jack M. Kamen, 440 Tippecanoe [52] US. Cl. 128/351, 128/246,[28/349 B [51] Int. Cl A6lm 25/00 [58] Field of Search 128/348, 349 R,349 B, 128/349 BV, 350 R, 351, 239, 246, 325, 344

[5 6] References Cited UNITED STATES PATENTS 2,701,559 2/1955 Cooper128/349 B X 3,292,627 12/1966 Harautuneian 128/349 B 2,862,498 l2/l958Weekes i 128/351 3,640,282 2/1972 Kamen et a] 128/35] 3,211,152 10/1965Stern 128/351 2,548,602 4/195l Greenburg 128/344 X 3,638,655 2/1972Doherty 128/351 Primary ExaminerDalton L. Truluck Attorney, Agent, orFirm-Root & OKeeffe [5 7] ABSTRACT A tracheal tube for use in intubatinga trachea, and which embodies passageways and openings therein which areconstituted and arranged in a manner particularly effective for thepassage of suction catheters, and the like, therethrough into bronchi,and the like.

5 Claims, 7 Drawing Figures TRACHEAL TUBES BACKGROUND OF THE INVENTIONThe present invention relates to tracheal tubes.

It is a primary object of the present invention to afford a noveltracheal tube.

Another object of the present invention is to enable a novel trachealtube to be afforded which is particularly well adapted for use inselectively inserting other instruments, such as suction catheters, andthe like, into desired position, such as, for example, into selectedones of a patients bronchi, and the like.

Another object is to afford a novel tracheal tube embodying a leading ordistal end for insertion into a patient, and in which the parts of thedistal end are constituted and arranged in a novel and expeditiousmanner.

Tubes for insertion into a patient, such as, for example, trachealtubes, catheters, enema tubes, and the like, heretofore known in theart, have had side openings therein for the passage of fluidstherethrough into and out of the patient. However, insofar as is known,all such openings in such tubular members have heretofore been disposedin positions, such as, for example, that of the side opening shown in myearlier U.S. Letters Pat. No. 3,640,382, issued Feb. 8, 1972, whereinthey were not well adapted for use in introducing suction catheters, andthe like, into a patient because passage of the catheters through theopenings would be obstructed or prevented by the portions of the tubeadjacent to the openings, or the suction catheters would pass out of theopenings at such an angle that they would impinge substantially directlyagainst the tracheal wall and injure the latter, and the like. It is animportant object of the present invention to afford a novel trachealtube which overcomes such disadvantages of tracheal tubes heretoforeknown in the art.

Another object of the present invention is to afford a novel trachealtube having side openings therein, which are constituted and arranged ina novel and expeditious manner effective to enable suction catheters,and the like, to be fed therethrough quickly and easily, and in a mannerwhich is not injurious to a patient.

Tracheal tubes, as that term is used herein, may be of different types,such as, for example, orotracheal tubes, nasotracheal tubes andtracheostomy tubes. Also, such tubes may be flexible, the main bodyportion thereof being made of flexible material, such as, for example,rubber or a suitable plastic material, such as, polyethylene, or thelike, or they may be stiff or rigid, being made of material such asstainless steel, or the like, the latter type of tubes being useful astracheostomy tubes. The present invention is intended for use in theconstruction of all such tracheal tubes.

As is well known in the art, tracheal tubes have commonly been insertedinto the trachea of a person for various purposes, such as, for example,to enable a person to breathe, or to enable intermittent positivepressure ventilation of the respiratory tract to be carried out. Often,it is highly important, particularly in such instances as when positivepressure ventilation of the respiratory tract is to be carried out, thatan airtight or substantially airtight seal be provided between thetracheal tube and the trachea. Various attempts have been madethere-tofore to effect such seals between tracheal tubes and thetrachea, such as, for example, by using large tubes which completelyfill the trachea, or

using cuffs which are mounted on the tubes and which are engageable withthe trachea. The cuffed tubes heretofore known in the art have includedtubes of the type shown in my aforementioned earlier issued U.S. Pat.No. 3,640,382, which have proven highly successful,

and which comprise a cuff, embodying a flexible, airimpervious coverdisposed in surrounding relation to a portion of the tube andhermetically sealed thereto, and a porous resilient body portion made ofsuitable material, such as, for example, sponge rubber, mounted aroundthe elongated tube, within the cover for yieldingly urging the coveroutwardly away from the tube. An auxiliary tube extends into the coverof the cuffed tubes of the last mentioned type, in hermetically sealedrelation thereto, and air may be withdrawn from the cover through theauxiliary tube to thereby cause the cuff to collapse to facilitate theinsertion thereof into a trachea, after which the auxiliary tube may beopened to the atmosphere to thereby permit the cuff to expand intoyielding, sealing engagement with the trachea.

Other cuffed tracheal tubes heretofore known in the art have includedthe type shown in the Stern U.S. Pat. No. 3,211,152, which issued Oct.12, 1965, wherein the cuffs are in the form of elastic diaphragms ortubes mounted on the main tube in surrounding relation thereto, with thecuff normally, and when being inserted into the trachea being inuninflated or deflated condition. With such devices, after theintubation device has been inserted into the trachea, the cuff isinflated, like a balloon, by feeding air or other working fluidthereinto at a positive pressure to thereby expand the cuff intoengagement with the inner wall of the trachea. It has been found thatsuch devices have several inherent disadvantages, such as, for example,commonly causing injury to the trachea.

Other cuffed tubes heretofore known in the art have included tubes ofthe type shown in U.S. Letters Pat. No. 3,638,655, issued to George 0.Doherty on Feb. 1, 1972, and which embodies a resilient, compressiblecuff, which should be lubricated prior to insertion into a trachea andwhich, during insertion into the trachea, is compressed and expands inaccordance with the size of the different portions of the tracheathrough which the cuff passes.

It is an object of the present invention to afford a novel tracheal tubewhich affords improvement over tracheal tubes heretofore known in theart.

A further object of the present invention is to afford a novel trachealtube, which, while it employs some of the principles of the highlyeffective tracheal tube disclosed in my aforementioned U.S. Pat. No.3,640,382, embodies improvements thereover.

Another object of the present invention is to afford a novel trachealtube embodying a cuff which is mounted on the sides and the end of thetubular member in a novel and expeditious manner.

Yet another object of the present invention is to afford a noveltracheal tube embodying a cuff which is effective, in a novel andexpeditious manner, to protect a trachea against injury by the distalend of the tube during insertion of the latter, and, also, while thetube remains disposed in such a trachea.

Another object of the present invention is to afford a novel trachealtube of the aforementioned type which embodies a novel, resilient cuff,which is normally disposed in expanded position, but which may beeffecthereof and what I now consider to be the best mode in which I havecontemplated applying these principles. Other embodiments of theinvention embodying the same or equivalent principles may be used andstructural changes may be made as desired by those skilled in the artwithout departing from the present invention and the purview of theappended claims.

DESCRIPTION OF THE DRAWINGS In the drawings:

FIG. 1 is a fragmentary, side elevational view of a tracheal tubeembodying the principles of the present invention;

FIG. 2 is a longitudinal sectional view taken substantially along theline 2-2 in FIG. 1, and showing the tracheal tube disposed in operativeposition in a trachea which is shown diagrammatically;

FIG. 3 is a side elevational view of the tracheal tube shown in FIG. 1,looking in the direction of FIG. 2, but showing the cuff on the trachealtube in collapsed posi tion;

FIG. 4 is a detail sectional view taken substantially along the line 4-4in FIG. 2;

FIG. 5 is a detail sectional view taken substantially along the line5--5 in FIG. 2;

FIG. 6 is a fragmentary, side elevational view of the distal end portionof a modified form of the present invention; and

FIG. 7 is an enlarged, detail sectional view taken substantially alongthe line 7-7 in FIG. 6, and showing the tracheal tube disposed inoperative position in a trachea, which is shown diagrammatically, andalso showing a suction catheter disposed in the tracheal tube andtrachea.

DESCRIPTION OF THE EMBODIMENTS SHOWN HEREIN A tracheal tube orintubation device 1, embodying the principles of the present invention,is shown in FIGS. l-5 of the drawings to illustrate the presentlypreferred embodiment of the present invention.

The tracheal tube 1 embodies, in general, an elongated tube 2 having acuff 3 mounted on one end portion thereof, with another tube 4 extendinginto the cuff 3 for a purpose which will be discussed in greater detailpresently. The tube 2 may be of any suitable construction and is for thepurpose of feeding air, or the like, into and out of the respiratorytract of a patient into whose trachea the tracheal tube or intubationdevice I has been inserted. Commonly, when the tracheal tube 1 is to beused as an endotracheal tube, such as, either an orotracheal ornasotracheal tube, the tube 2 thereof is preferably flexible and may bemade of any suitable material such as, for example, rubber or a suitableplastic, such as polyethylene, or the like. However, in other instances,such as, for example, when the tracheal tube 1 is to be used as atracheostomy tube, it may be desired to have the tube 2 thereof be rigidin construction and made of suitable material such as, for example,stainless steel, or the like.

The tube 2, shown in FIGS. 1-5, embodies a front end or distal endportion 5, which is somewhat U- shaped in construction, embodying afront wall 6 and two oppositely disposed side walls 7 and 8 projectingrearwardly from respective ends of the front wall 6 toward the proximalend 9 of the tube 2, FIG. 2. Preferably, the tube 2 is round in crosssectional shape and is uniform in cross sectional size, such as, forexample, having an outside diameter in the nature of seven/onesixteenthof an inch, throughout its length, rearwardly of the distal end portion5. A passageway 10, which, preferably, is relatively large in size, suchas, for example, having a diameter of five/sixteenth of an inch, extendsthrough the tube 2 from the proximal end 9 thereof into the distal endportion 5 thereof.

The walls 6-8 of the distal end portion 5 of the tube 2 preferably areuniform in width, and preferably are substantially narrower in widththan the remainder of the tube 2, such as, for example, having a widthin the nature of one-half to three-fourths of the outside diameter ofthe remainder of the tube 2, and, preferably, in the nature oftwo-thirds thereof. An opening 11 extends transversely through thedistal end portion 5, between the side walls 7 and 8 thereof. The upperside 12 and the lower side 13 of the opening 11, as viewed in FIG. 2,are defined by the inner faces of the side walls 7 and 8, respectively,and the front side 14 of the opening 11 is defined by the inner face ofthe front wall 6. The rear side 15 of the opening 11 preferably isdisposed at the junction of the distal end portion 5 with the remainderof the tube 2. The inner face of each of the walls 6-8 preferably isflat in a direction perpendiculr to the length of the tube 2, asillustrated with respect to the side walls 7 and 8 in FIG. 5, or isconvex inwardly, for a purpose which will be discussed in greater detailpresently. Also, preferably, the walls 7 and 8 are spaced from eachother the diameter of the passageway 10 so as to afford unobstructedcommunication between the passageway 10 and the opening 11.

The cuff 3, FIGS. 2 and 4, includes an air-impervious cover 16 and abody portion 17 disposed within the cover 16. The cuff 3 embodies a mainportion 18, a front end portion 19 and a rear end portion 20, FIGS. 1and 2, the end portions 19 and 20 being smaller in cross sectional sizethan the main portion 18, as will be discussed in greater detailpresently.

The main portion 18 of the cuff 3 preferably is substantially ellipticalin shape, in longitudinal cross section, when it is in fully expandedposition, as shown in FIG. 1, and the body portion 17 and the coverportion 16 of the main portion 18 are disposed around a portion of thetube 2, in surrounding relation thereto, immediately adjacent and inrearwardly extending relation to the distal end portion 5. The portionsof the cover 16 disposed around the main portion 18 and the rear endportion 20 of the cuff 3 are tubular in form, and the portion of thecover 16, which defines the rear end portion 20 of the cuff 3, ishermetically sealed to the outer surface of the tube 2 by suitablemeans, such as, for example, being vulcanized thereto or by a suitablecement such as rubber cement, or the like. In the preferred form of theintubation device 1 shown in the drawings, reinforcing rings 20 aremounted on the end portion 20 of the cuff 3 to insure the maintenance ofan effective seal between the end portion 20 and the tube 2. Thereinformcing rings 20' may be made of any suitable material such asrubber or a suitable plastic such as polyethylene amd may be secured tothe outer face of the end portion 20 by suitable means such asvulcanization or a suitable cement.

The front end portion 19 of the cuff 3, like the main portion 18 thereofembodies a portion of the body portion 17 and of the cover 16. It issubstantially U-shaped, having a front end portion 21 disposed incovering relation to the front wall 6 of the distal end portion 5 of thetube 2, and two legs 22 and 23 projecting rearwardly from the front endportion 21 in covering relation to the outer faces of the side walls 7and 8 of the distal end portion 5, respectively. The front end portion19 of the cuff 3 preferably is relatively narrow in width, preferablybeing of such width that it will just cover the outer peripheral face ofthe distal end portion 5 of the tube 2. The portion of the cover 16disposed on the distal end portio 5 of the tube 2 is hermetically sealedby suitable means, such as vulcanization or cement, or the like, alongits respective longitudinal edges 24 and 25, FIG. 5, to respective sidesof the distal end portion 5 along a line 26, FIG. 3, which extends alongthe sides 12-14 of the opening 11 and terminates at its rear ends, atrespective ends of a line 27, FIG. 3, along which the front edge of theportion of the cover portion 16 of the main portion 18 of the cuff 3 issimilarly hermetically sealed to the outer surface of the correspondingside of the tube 2 between the legs 22 and 23 of the front end portion19 of the cuff 3.

The cover 16 is flexible and may be made of any suitable material, suchas, for example, latex rubber or a suitable plastic sheet material, suchas, polyethylene, or the like. Preferably, it also is elastic forreasons which will be discussed in greater detail presently, and, ofcourse, under such circumstances it would be made of a suitable elasticmaterial such as the aforementioned latex rubber.

The body portion 17 of the cuff 3 affords a resilient mass whichpreferably completely fills the cover 16 forwardly of the end portion 20thereof and, when the intubation device 1 is disposed in normalinoperative position, outside the trachea, preferably is effective toyieldingly hold the cover 16 in fully expanded position, as shown inFIG. 1. The body portion may be made of any suitable resilient material,but, preferably, is made of a sponge-like resilient material having amultitude of interstices spread therethrough, such as, for example,sponge rubber or a suitable resilient plastic material, such as, forexample, foamed polyurethane, or the like, for a purpose which will bediscussed in greater detail presently.

The tube 4 has one end portion 28, FIG. 2, extending into the cuff 3. Asshown in the drawings, the tube 4 extends along the tube 2, preferably,the tube 4 is formed integrally with the tube 2 and terminates in a freeend portion 29 which extends outwardly beyond the proximal end 9 of thetube 2. However, as will be appreciated by those skilled in the art, thetube 4 may be formed separately from the tube 2 and inserted into thecuff 3 in a suitable manner without departing from the purview of thebroader aspects of the present invention.

In the intubation device 1 shown in the drawings, wherein the tube 4extends along the tube 2, FIG. 2, the tube 4 extends through the endportion 20 of the cuff 3, and the portion of the cover 16, which affordsthe end portion 20, is hermetically sealed to the tube 4 in the samemanner as it is so sealed to the tube 2. With this construction, it willbe seen that when the tube 4 is open to the atmosphere throughout itslength, and the intubation device 1 is disposed outside ofa trachea, thebody portion 17 is effective to yieldingly hold the cover 16 in fullyoutwardly extended position, as shown in FIG. 1. However, by theapplication of a vacuum to the end portion 29 of the tube 4, air may bewithdrawn from within the cover 16 through the tube 4 to thereby afforda partial vacuum within the cuff 3 and cause the main portion 18 and thefront end portion 19 thereof to collapse from the position shown in FIG.1 to a position such as that shown in FIG. 3, because of the imbalancebetween the pressure within the cover 16 and the atmospheric pressureexteriorly thereof. It will be seen that by making the body portion 17of the cuff 3 of a resilient material having interstices therein, suchas, for example, the aforementioned foam rubber or foamed polyurethane,as in my aforementioned US. Pat. No. 3,640,282, the withdrawal of airfrom within the cover 16 may be substantially uniform throughout theentire area between the end portion 20 and the front end of the cuff 3,so as to effect a substantially complete collapse of all portions of thecover 9 forwardly of the end portion 20 thereof.

With the intubation device 1 constructed in the aforementioned manner,when it is desired to insert it into a trachea, such as the trachea 30diagrammatically shown in FIGS. 2-4, a partial vacuum may be applied tothe end portion 29 of the tube 4 to thereby cause the cuff 3 to movefrom its normal expanded position shown in FIG. 1 to a collpasedposition such as that shown in FIG. 3. While maintaining the vacuum onthe tube 4, the tracheal tube 1 may be inserted into a trachea, such asthe trachea 30, the cuff being disposed in the aforementioned collapsedposition to thereby facilitate such insertion. Thereafter, when thetracheal tube 1 has been inserted into the desired position in thetrachea 30, the vacuum on the tube 4 may be released to thereby permitthe cover 16 to be expanded outwardly by the yielding expansion of theresilient body member 17, the expansion of the cover from the collapsedposition being to a position wherein it is yieldingly held by the bodyportion 17 in engagement with the inner wall 31 of the trachea 30, suchas shown in FIGS. 2 and 4. Such expansion, it will be seen, is caused bythe resiliency of the body portion 17 and is a direct result of thevolumetric expansion thereof.

This is to be distinguished from the expansion of the aforementionedcuffs heretofore known in the art, which cuffs are expanded by theapplication of a positive pressure, by the introduction of air or otherworking fluid thereinto under pressure.

Although it is of little or no importance whether the cover 16 iswrinkled when the cuff 3 is in fully collapsed position, as shown inFIG. 3, and it is not essential or an absolute requirement that nowrinkles be formed in the cover 16 when the cuff 3 is disposed inoperative engagement with the trachea, such as is shown in FIG. 2, it ispreferred that no such wrinkles be present when the cuff 3 is inoperative engagement with the trachea. Therefore, to insure against suchwrinkles, we prefer that the cover 16 be made of a suitable elasticmaterial such as, for example, the aforementioned latex rubber, which isstretched by the expansion of the body portion 17.

As will be appreciated by those skilled in the art, the size of the cuff3 in its normal, fully expanded state, as shown in FIG. 1, and thecharacteristics of the cover 16 and the body portion 17 are factors inthe determination of the pressure with which the cuff 3 pressesoutwardly on a trachea, such as the trachea 30 when it is disposed inoperative engagement with the inner wall 31 of such a trachea.Preferably, the size of the cuff 3 and the characteristics of the cover16 and the body portion 17 are such that the outward pressure of thecuff 3 on a trachea is no greater than 25 centimeters of water, when theintubation device 1 is in normal operative position in the trachea andthe cuff 3 is in effective sealing engagement with the latter.

However, as will be appreciated by those skilled in the art, this is setforth merely by way of illustration of the preferred embodiment of thepresent invention and not by way of limitation, and variations in thesize and characteristics of the cuff 3 may be made by those skilled inthe art without departing from the purview of the present invention.

It will be seen that the cuff 3 embodied in the intubation device 1shown in FIGS. 1-5 of the drawings, not only affords an effective meansfor sealing the intubuation device 1 against leakage therepast in thetrachea, but it affords effective protection against injury to thetrachea during insertion of the intubation device into the trachea.Whereas, insofar as is known, cuffs on tracheal tubes heretofore knownin the art always have been disposed in rearwardly spaced relation tothe front or distal end of such tracheal tubes, the cuff 3, includingboth the cover portion 16 and the body portion 17 thereof, not onlyextends around the tube 2, rearwardly of the distal end portion thereof,but also extends around the outer peripheral surface of the distal endportion 5 in covering relation thereto. Thus, even in collapsedposition, as shown in FIG. 3, the cuff 3 affords an effective pad forpreventing injury to the trachea by engagement of the front end portionof the tube 2 therewith, and is particularly effective to prevent injuryto such a trachea by the direct impingement of the front end of thetracheal tube 1 against a portion of the trachea, both during insertionof the tracheal tube 1 into the trachea and during the time that thetracheal tube 1 remains in the trachea. In addition, the intubationdevice 1, shown in FIGS. l-S, affords a novel and effective trachealtube, the construction of which is such that other instruments, such assuction catheters, and the like, may be readily, selectively insertedtherethrough into various positions in a patient, as will be discussedin greater detail hereinafter.

A modified form of my intubation tube is shown in FIGS. 6 and 7, andparts which are the same as parts shown in FIGS. 1-5 are indicated bythe same reference numerals as used in FIGS. 1-5, and parts which aresimilar but have been substituted for parts of the preferred form of myinvention shown in FIGS. 1-5 are indicated by the same referencenumerals with the suffix a added thereto. All of the changes made in themodified form of my invention over the preferred form as shown areembodied in the cuff 3a attached to the tube 2.

The tracheal tube or intubation device la shown in FIGS. 6 and 7 is thesame in construction and mode of operation as the tracheal tube shown inFIGS. l-S, except that the front end portion 32 of the cuff 3aterminates on the tube 2 adjacent to, but rearwardly of the distal end 5thereof, and like the rear end portion 20 of the cuff 3 comprises merelya portion of the cover 16a, which is hermetically sealed by suitablemeans, such as, for example, vulcanization or cement to the outersurface of the tube 2. A reinforcing ring 33, like the reinforcing ring20 on the rear end portion 20, preferably is mounted on the end portion32 of the cuff 3a to insure the maintenance of an effective seal betweenthe end portion 32 and the tube 2.

Thus, the cuff 3a of the tracheal tube 1a, unlike the cuff 3 of thetracheal tube 1, does not extend across the distal end portion 5 of thetube 2 in covering relation thereto. However, the distal end portion 5of the tube 2, shown in FIGS. 6 and 7, which projects forwardly from thefront end portion 32 of the cuff 3a, is identical in construction and inpositioning relative to the remainder of the tube 2 as in the trachealtube 1 shown in FIGS. l-5.

The tracheal tube la may be inserted into and then sealingly engagedwith a trachea in the same manner as heretofore discussed with respectto the tracheal tube 1, by collapsing the cuff 3a, inserting thetracheal tube 1a into the desired position in the trachea, and thenpermitting the cuff 3a to expand into sealing engagement with thelatter. This, it will be seen, affords a highly effective and practicaltracheal tube for enabling a person to breathe, or to enableintermittent positive pressure ventilation of the respiratory tract tobe carried out.

However, the tracheal tube Ia has another important advantage overtracheal tubes heretofore known in the art, as does the tracheal tube 1as will now be discussed. Thus, oftentimes it is desirable or necessaryto withdraw liquid, such as mucus from cavities within a patient, suchas, for example, from within the bronchi of the patient. This commonlyis done by inserting suitable suction tubes, such as suction cathetersheretofore well known in the art, through the trachea into the desiredposition. In the past, this commonly has been done by passing thesuction catheter directly through the trachea, or by passing it througha tracheal tube which is completely open at the front or inner endthereof. This often is difficult procedure, particularly when it isnecessary to selectively insert the suction catheter into a particularposition, such as, for example, into the left or right bronchus. Thepresent invention, both in the form shown in FIGS. l-5 and in the formshown in FIGS. 6 and 7, affords a novel tracheal tube which is highlyeffective in assisting in such insertion of another instrument, such assuction catheter, into desired position in a patient.

For this purpose, using either the tracheal tube la or the tracheal tube1, the tracheal tube may be inserted into a trachea into a desiredposition, such as, for example, the position shown for the tracheal tubela in FIG. 7 for the insertion of a suction catheter into one of thebronchi of a patient. In this position of the tracheal tube la, thedistal end 5 of the tube 2 is disposed in closely adjacent relation tothe junction 34 between the left bronchus 35 and the right bronchus 36,and is disposed in uniplanar relation to the plane of separation betweenthe bronchi 35 and 36. With the tracheal tube la thus positioned, asuitable suction tube, such as, for example, the suction catheter 37,shown in FIG. 7, may be inserted longitudinally through the tube 2 fromthe proximal end 9 into the distal end portion 5 thereof. From thatposition, the operator may readily manipulate the tube 37 so that it maybe further advanced through tthe upper or lower side of the opening 11in the distal end portion 5, as viewed in FIG. 7, into the rightbronchus 36 or the left bronchus 35, respectively. The front endportions of such suction tubes used for this purpose, such as, forexample, the front end portion 38 of the tube 37, commonly are preset atan angle relative to the adjacent portion of the tubes, in the mannerillustrated in FIG. 7. With the suction catheter so constructed, it willbe seen that the front end portion 38 may be readily inserted throughthe tube 2 in such position, that when it enters the distal end 5 of thetube 2 it automatically is guided thereby into the desired bronchus 35or 36.

It will be seen that with the distal end 5- of the tube 2 constitutedand arranged in the manner disclosed herein, no obstruction is affordedthereby to the passage of an instrument, such as the suction catheter37, laterally outwardly through the opening 11. It will be rememberedthat the inner faces of the walls 6-8 of the distal end 5 of the tube 2preferably are perpendicular, in a lateral direction, to thelongitudinal center line of the distal end portion 5, or are convexinwardly. With such construction, no obstruction is afforded on thedistal end 5 to catch the front end of an instrument, such as the tube37, and obstruct or interfere with the passage thereof laterallyoutwardly through the opening 11, and, in fact, the inner faces of thewalls 6-8 act as guide surfaces for guiding the front end portions ofsuction tubes, and the like, such as, for example, the front end 38 ofthe tube 37, outwardly through the opening 11 in the proper direction.

Thus it will be seen that the tracheal tube la, shown in FIGS. 6 and 7,afford a novel tracheal tube which may be quickly and easily disposed inoperative position in a trachea, or the like, in sealing engagementtherewith, for the passage of air, or the like, therethrough, and whichalso affords a novel and practical device for effectively assisting inthe selective positioning of other instruments, such as, for example,suction catheters in or beyond the trachea.

Similarly, it will be seen that the tracheal tube 1 shown in FIGS. 1-5of the drawings, has the same advantages of construction and mode ofoperation as the tracheal tube Ia, and, in addition, embodies a cuffwhich protects against contact betwen the distal end 5 of the trachealtube 1 and the trachea, which would be injurious to the latter, bothduring the insertion of the tracheal tube 1 into the trachea, and duringthe time that it is so positioned in the trachea.

It will be appreciated by those skilled in the art that although theopening 11 in the distal end portion 5 of the tube 2 in each of thetracheal tubes 1 and 1a is shown as extending completely through thedistal end portion 5, this is merely by way of illustration of thepreferred construction of the tracheal tubes 1 and la, and not by way oflimitation, and, if desired, the opening 11, which is in communicationwith the passageway may be only in one side of the distal end 5 of thetube 2 of either of the tracheal tubes 1 or la without departing fromthe purview of the broader aspects of the present invention. In thatevent, I prefer to afford a stripe or other indicia, not shown, on theproximal end portion of the tubes 2, with the stripe, or the like,positioned so as to indicate to the operator the direction in which theopening in the distal end of the tube is facing.

From the foregoing it will be seen that the present invention affords anovel intubation device embodying a cuff which is constituted andarranged in a novel and expeditious manner.

Also, it will be seen that the present invention affords a novelintubation device for use in tracheae wherein the parts thereof areconstituted and arranged in a novel and expeditious manner effective toafford a device for effectively assisting in the insertion of otherinstruments, such as, for example, suction catheters, and the like, intoa patient.

Thus, while I have illustrated and described the preferred embodimentsof my invention, it is to be understood that these are capable ofvariation and modification, and I therefore do not wish to be limited tothe precise details set forth, but desire to avail myself of suchchanges and alterations as fall within the purview of the followingclaims.

I claim:

1. A tracheal tube comprising a. an elongated tube having 1. a distalend portion having a. an end wall,

2. a proximal end, and

3. a passageway extending longitudinally through said proximal end intosaid distal end portion,

b. said distal end portion 1. being narrower in width transversely tothe length of said tube than the portion of said tube adjacent saiddistal end portion, and

2. having a transverse opening therein in communication with saidpassageway,

c. said transverse opening 1. being defined on one side by said endwall, and

2. extending from said end wall toward said proximal end, and d. a cuff(I) mounted on and extending around the outer surface of said portion ofsaid tube which is adjacent to said distal end portion, and also (2)mounted on and extending along the outer surface of said end walloutwardly of said opening, said cuff having means therein normallyexpanding said cuff away from both said outer surfaces.

2. A tracheal tube as defined in claim 1, and in which a. saidtransverse opening extends through two opposite sides of said distal endportion,

b. said distal end portion includes two oppositely disposed side wallsextending from said end wall toward said proximal end in spaced relationto each other,

c. said side walls define respective opposite sides 0 said opening, andd. said cuff is mounted on and extends along the outer peripheralsurface of said side walls outwardly of said opening.

3. A tracheal tube as defined in claim 2, and in which a. said distalend portion extends along the longitudinal center line of said elongatedtube.

4. A tracheal tube as defined in claim 3, and in which a. said cuff has1 a normal position wherein it is disposed in outwardly expandedposition relative to said elongated tube, and 2 another position whereinit extends a lesser distance from said elongated tube than in saidnormal position, and b. said cuff includes resilient means for normallyyieldingly holding said cuff in said normal position.

5. A tracheal tube as defined in claim 3, and a in which said cuffcomprises 1. a flxible cover mounted on a. said portion of saidelongated tube which is adjacent said distal end portion, b. said sidewalls, and c. said end wall, and

2. a resilient body portion a. mounted in said cover, and b. having (1')normally an expanded position, wherein it is effective to hold a portionof said cover outwardly away from said portion and walls of saidelongated tube, and (2') a collapsed position, wherein the outer surfacethereof is disposed closer to said elongated tube than in said expandedposition to thereby permit said portion of said cover to assume aposition closer to said elongated tube, and b. which includes meansconnected to said cuff for creating and releasing a vacuum in said coverto thereby cause said body portion to move toward said collapsed andexpanded positions, respectively.

1. A tracheal tube comprising a. an elongated tube having
 1. a distalend portion having a. an end wall,
 2. a proximal end, and
 3. apassageway extending longitudinally through said proximal end into saiddistal end portion, b. said distal end portion
 1. being narrower inwidth transversely to the length of said tube than the portion of saidtube adjacent said distal end portion, and
 2. having a transverseopening therein in communication with said passageway, c. saidtransverse opening
 1. being defined on one side by said end wall, and 2.extending from said end wall toward said proximal end, and d. a cuff (1)mounted on and extending around the outer surface of said portion ofsaid tube which is adjacent to said distal end portion, and also (2)mounted on and extending along the outer surface of said end walloutwardly of said opening, said cuff having means therein normallyexpanding said cuff away from both said outer surfaces.
 2. a proximalend, and
 2. having a transverse opening therein in communication withsaid passageway, c. said transverse opening
 2. extending from said endwall toward said proximal end, and d. a cuff (1) mounted on andextending around the outer surface of said portion of said tube which isadjacent to said distal end portion, and also (2) mounted on andextending along the outer surface of said end wall outwardly of saidopening, said cuff having means therein normally expanding said cuffaway from both said outer surfaces.
 2. A tracheal tube as defined inclaim 1, and in which a. said transverse opening extends through twoopposite sides of said distal end portion, b. said distal end portionincludes two oppositely disposed side walls extending from said end walltoward said proximal end in spaced relation to each other, c. said sidewalls define respective opposite sides of said opening, and d. said cuffis mounted on and extends along the outer peripheral surface of saidside walls outwardly of said opening.
 2. a resilient body portion a.mounted in said cover, and b. having (1'') normally an expandedposition, wherein it is effective to hold a portion of said coveroutwardly away from said portion and walls of said elongated tube, and(2'') a collapsed position, wherein the outer surface thereof isdisposed closer to said elongated tube than in said expanded position tothereby permit said portion of said cover to assume a position closer tosaid elongated tube, and b. which includes means connected to said cufffor creating and releasing a vacuum in said cover to thereby cause saidbody portion to move toward said collapsed and expanded positions,respectively.
 3. A tracheal tube as defined in claim 2, and in which a.said distal end portion extends along the longitudinal center line ofsaid elongated tube.
 3. a passageway extending longitudinally throughsaid proximal end into said distal end portion, b. said distal endportion
 4. A tracheal tube as defined in claim 3, and in which a. saidcuff has 1 a normal position wherein it is disposed in outwardlyexpanded position relative to said elongated tube, and 2 anotherposition wherein it extends a lesser distance from said elongated tubethan in said normal position, and b. said cuff includes resilient meansfor normally yieldingly holding said cuff in said normal position.
 5. Atracheal tube as defIned in claim 3, and a. in which said cuff comprises